In this sobering piece, O’Rourke writes, “In the course of our lives, most of us will urgently need care, sometimes when we least expect it. Currently, we must seek it in a system that excels at stripping our medical shepherds of their humanity, leaving them shells of the doctors (and people) they want to be, and us alone in the sterile rooms they manage. What makes our predicament so puzzling, and what may offer hope, is that nearly all of us want a different outcome. I used to think that change was necessary for the patient’s sake. Now I see that it’s necessary for the doctor’s sake, too.”

The piece focuses on problems and pain; it does not aim to explore the fulfilling aspects of medicine that keep so many physicians devoted to their careers.

Health care’s future will depend on the growing, determined movement we are all building together to address what ails us. Please share your thoughts on this provocative piece in the comments thread below.

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3 Responses to “Is it All Bad?”

it is possible to use a computer and listen actively but it is a skill that must be learned and practices. But it is true that we really do need more time to slow down and examine carefully. So, the problem seems to be equating volume with productivity and not being clever enough to figure out how to measure and reward quality. PQRS isn’t the answer. These measures make us take our eyes off the patient and focus on making sure the computer proves we are doing the silly jobs CMS has decided to pay attention to. It seems to me the only way we will get past this crisis is for doctors to get organized and fight the system to its core and rebuild our profession from the ground up. We need to be able to stop multitasking and start listening to, touching and teaching our patients. After all, isn’t this our life’s mission?

I found this article really interesting, although I wished O’Rourke had spent more time exploring the policies that incentivized this sort of behavior among physicians (the patient autonomy movement and the threat of lawsuits have been important, but the steady march of managed care has probably played a bigger role.) Interestingly, she doesn’t mention the only movement on a national scale that is trying to address these concerns– one that has minimal policy support, unfortunately– which is Direct Primary Care. However, DPC pretty much calls for near-total deregulation of payment– whichisn’t advantageous for most entrenched interests.

I found myself feeling very defensive reading this article. As an emergency physician, I strive to retain my humanity in the face of often inhumane acts and situations and unfortunately frequent violent and threatening patients and visitors. I also am honored to work beside nurses and staff who are amazingly consistently compassionate. I also agree with Matthew Loftus that some other aspects need to be explored in this conversation. In my career, there is often no time for “slow medicine”, but that doesn’t mean “It’s [all] Bad”.